Visits for Primary Care Services to Primary Care and Specialty Care Physicians, 1999 and 2007

While nonvisit care has the potential of improving access to care by reducing office visits 1 and patient outcomes, 2,3 such nonvisit care leads to a substantial physician workload that is by in large invisible and nonreimbursed.If the non-face-to-face tasks associated with providing primary care are not recognized and accounted for, the workload of primary care physicians will likely become unsustainable as demand for access increases.Higher workloads will inevitably result in longer work hours, which have been shown to be a key driver of physician burnout and career dissatisfaction 4 -both of which have a negative impact on quality of care and access to care. 5 Although nonvisit care tasks are often invisible to payers and consumers, medical students are acutely aware and believe the paperwork burden of primary care physicians to be substantially higher than that of other specialties, 6 a factor that may have a negative impact on their view of primary care as a specialty choice.To ensure an adequate physician work force to provide primary care, it will be critical that health care reform adequately compensates physicians for nonvisit care and supports improved efficiency in delivering all aspects of care.Unfortunately, discussions about addressing inefficiencies in nonvisit care have been minimal to date.[7][8][9] Provision of primary care requires a substantial number of tasks beyond face-to-face patient interactions.Although vital to the actualization of health care reform goals (eg, increase preventative care, better manage chronic diseases, improve health care quality, decrease hospital readmissions), much of this work is unrecognized.Efforts to improve practice efficiency and increase access to primary care providers must take into account these important but underappreciated tasks.